# Pfirrmann — Pfirrmann grading of lumbar disc degeneration

> Per-disc lumbar MRI grading that combines T2 structure, nucleus-annulus distinction, signal intensity and disc height; it describes degeneration morphology and does not classify herniation, symptoms or treatment need.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Pfirrmann et al. · **Versão:** original five-grade system (2001) · **Ano:** 2001

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Apply the original four-feature matrix per lumbar disc. Preserve discordant features and version identity; never turn a morphology grade into a pain diagnosis or treatment command.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Grade I | Grade I: homogeneous, bright-white disc structure; a clear nucleus pulposus-annulus fibrosus distinction; T2 signal hyperintense and isointense to cerebrospinal fluid; and normal intervertebral-disc height. | Report Grade I with its four supporting features at the specific lumbar level. The grade does not direct treatment; correlate symptoms and any intervention decision with the neurologic examination and separate structural findings. | This is the least degenerated morphology in the original five-grade system, but it supplies no probability of pain, future degeneration, neurologic deficit or need for intervention and does not exclude another pain generator. | Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade I; Methods specify grading on T2-weighted midsagittal images; Discussion defines the system as gross disc morphology rather than a symptom or treatment scale. | ✓ |
| II | Grade II | Grade II: inhomogeneous disc structure, with or without horizontal bands; the nucleus-annulus distinction remains clear; T2 signal remains hyperintense and isointense to cerebrospinal fluid; and disc height remains normal. | Document the inhomogeneity or horizontal bands while preserving the normal height and high signal that distinguish Grade II. No surveillance, procedure or operation follows from Grade II alone; correlate clinically and report other abnormalities separately. | Grade II denotes early morphologic change relative to Grade I, not a calibrated risk stratum. The original publication gives no per-grade probability of symptoms, progression, work limitation or later treatment. | Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade II; Results and Discussion describe reliability and note that disagreements were relatively frequent at the I-II boundary. | ✓ |
| III | Grade III | Grade III: inhomogeneous gray disc structure; an unclear nucleus-annulus distinction; intermediate T2 signal; and disc height that is normal to slightly decreased. | Report every defining feature and the lumbar level, then describe herniation, stenosis, endplate change and neural effect independently. Grade III alone neither establishes a symptomatic pain generator nor selects conservative or operative care. | Grade III is an intermediate morphologic category. The five-grade scale does not attach a patient-specific likelihood of pain, progression, instability, neurologic compromise or intervention to this label. | Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade III; Discussion states that height does not discriminate Grade III from Grade IV and that the system assesses gross morphology. | ✓ |
| IV | Grade IV | Grade IV: inhomogeneous gray-to-black disc structure; loss of the nucleus-annulus distinction; intermediate-to-hypointense T2 signal; and disc height ranging from normal to moderately decreased, without the collapsed space required for Grade V. | Describe the advanced morphologic features and preserve the actual disc-height category. Treatment still depends on symptoms, neurologic findings, instability, herniation and stenosis; a dark Grade IV disc is not by itself an indication for a procedure. | Grade IV denotes advanced degeneration morphology but is not a prognosis. The original system does not quantify pain, progression, nerve injury or surgical probability, and height overlap with Grade III limits single-feature inference. | Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade IV; Discussion states that height is not discriminative for III versus IV and is important for distinguishing IV from V. | ✓ |
| V | Grade V | Grade V: inhomogeneous black disc structure; lost nucleus-annulus distinction; hypointense T2 signal; and a collapsed disc space. All four features should support end-stage morphology rather than assigning V from reduced height alone. | Report collapse and the complete feature pattern, then separately describe neural compression, deformity, instability and postoperative status. Grade V alone does not mandate surgery; exclude congenital or transitional-disc hypoplasia when height and signal conflict. | This is the most advanced morphology in the original five-grade system, but it remains an ordinal imaging label without an individual probability of pain, disability, neurologic deficit, progression or treatment response. | Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade V; Discussion explains height as the IV-V discriminator and describes a sacralized transitional level misgraded V when marked smallness conflicted with Grade-II-like signal. | ✓ |

### Citações por categoria
- **I**: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/ · Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade I; Methods specify grading on T2-weighted midsagittal images; Discussion defines the system as gross disc morphology rather than a symptom or treatment scale.
- **II**: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/ · Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade II; Results and Discussion describe reliability and note that disagreements were relatively frequent at the I-II boundary.
- **III**: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/ · Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade III; Discussion states that height does not discriminate Grade III from Grade IV and that the system assesses gross morphology.
- **IV**: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/ · Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade IV; Discussion states that height is not discriminative for III versus IV and is important for distinguishing IV from V.
- **V**: Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration (2001) — https://pubmed.ncbi.nlm.nih.gov/11568697/ · Pfirrmann et al., Spine 2001;26:1873-1878, Table 1, Grade V; Discussion explains height as the IV-V discriminator and describes a sacralized transitional level misgraded V when marked smallness conflicted with Grade-II-like signal.

## Referências cruzadas
- _fronteira compartilhada_ → [Modic — Modic vertebral endplate marrow changes](https://radcommons.laudos.ai/systems/modic.md) — Complementary to Modic endplate changes when grading lumbar degeneration.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2001-09-01 | published | Pfirrmann disc degeneration grading published in Spine. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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